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General NPI Number Information
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NPI Number | 1871026831
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Entity Type | Individual
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Provider Name | MASARU NISHIAOKI MD
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Gender | Male
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Dates
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Enumeration Date | 04/06/2017
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 4509 WHITECHAPEL DRIVE
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455
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Country | US
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Telephone | 757-460-4655
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Fax | 757-460-7744
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Provider Business Mailing Address
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Address Line | 4509 WHITECHAPEL DRIVE
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455
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Country | US
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Telephone | 757-460-4655
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Fax | 757-460-7744
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 0101268181
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License Number State | VA
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